Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy.
Medicina (Kaunas). 2020 Apr 24;56(4):205. doi: 10.3390/medicina56040205.
Trauma coagulopathy begins at the moment of trauma. This study investigated whether coagulopathy upon arrival in the emergency room (ER) is correlated with increased hemotransfusion requirement, more hemodynamic instability, more severe anatomical damage, a greater need for hospitalization, and hospitalization in the intensive care unit (ICU). We also analyzed whether trauma coagulopathy is correlated with unfavorable indices, such as acidemia, lactate increase, and base excess (BE) increase. We conducted a prospective, monocentric, observational study of all patients ( = 503) referred to the Department of Emergency and Acceptance, IRCCS Fondazione Policlinico San Matteo, Pavia, for major trauma from 1 January 2018 to 30 January 2019. Of the 503 patients, 204 had trauma coagulopathy (group 1), whereas 299 patients (group 2) did not. Group 1 had a higher hemotransfusion rate than group 2. In group 1, 15% of patients showed hemodynamic instability compared with only 8% of group 2. The shock index (SI) distribution was worse in group 1 than in group 2. Group 1 was more often hypotensive, tachycardic, and with low oxygen saturation, and had a more severe injury severity score than group 2. In addition, 47% of group 1 had three or more body districts involved compared with 23% of group 2. The hospitalization rate was higher in group 1 than in group 2 (76% vs. 58%). The length of hospitalization was >10 days for 45% of group 1 compared with 28% of group 2. The hospitalization rate in the ICU was higher in group 1 than in group 2 (22% vs. 14.8%). The average duration of ICU hospitalization was longer in group 1 than in group 2 (12.5 vs. 9.78 days). Mortality was higher in group 1 than in group 2 (3.92% vs. 0.98%). Group 1 more often had acidemia and high lactates than group 2. Group 1 also more often had BE <-6. Trauma coagulopathy patients, upon arrival in the ER, have greater hemotransfusion ( = 0.016) requirements and need hospitalization ( = 0.032) more frequently than patients without trauma coagulopathy. Trauma coagulopathy seems to be more present in patients with a higher injury severity score (ISS) ( = 0.000) and a greater number of anatomical districts involved ( = 0.000). Head trauma ( = 0.000) and abdominal trauma ( = 0.057) seem related to the development of trauma coagulopathy. Males seem more exposed than females in developing trauma coagulopathy ( = 0.018). Upon arrival in the ER, the presence of tachycardia or alteration of SI and its derivatives can allow early detection of patients with trauma coagulopathy.
创伤性凝血病始于创伤发生之时。本研究旨在探讨急诊（ER）时的凝血病是否与输血需求增加、血流动力学更不稳定、更严重的解剖损伤、住院需求增加以及入住重症监护病房（ICU）相关。我们还分析了创伤性凝血病是否与酸中毒、乳酸升高和碱缺失（BE）增加等不良指标相关。
我们对 2018 年 1 月 1 日至 2019 年 1 月 30 日期间因严重创伤被送往意大利帕维亚圣马特奥基金会综合医院急诊和急诊科的所有患者（=503 例）进行了前瞻性、单中心、观察性研究。503 例患者中，204 例有创伤性凝血病（组 1），而 299 例（组 2）无创伤性凝血病。组 1 的输血率高于组 2。组 1 中有 15%的患者出现血流动力学不稳定，而组 2 中只有 8%。组 1 的休克指数（SI）分布比组 2 差。组 1 更常出现低血压、心动过速和低血氧饱和度，且损伤严重程度评分高于组 2。此外，组 1 中有 47%的患者有三个或更多身体部位受累，而组 2 中只有 23%。组 1 的住院率高于组 2（76%比 58%）。组 1 的住院时间>10 天的比例为 45%，组 2 为 28%。组 1 的 ICU 住院率高于组 2（22%比 14.8%）。组 1 的 ICU 平均住院时间长于组 2（12.5 比 9.78 天）。组 1 的死亡率高于组 2（3.92%比 0.98%）。组 1 酸中毒和高乳酸血症的发生率高于组 2。组 1 的 BE 值<-6 的发生率也高于组 2。
创伤性凝血病患者在到达急诊室时需要更多的输血（=0.016），且需要更频繁地住院（=0.032）。与无创伤性凝血病的患者相比，创伤性凝血病患者的损伤严重程度评分（ISS）更高（=0.000），受累的解剖部位也更多（=0.000）。头部创伤（=0.000）和腹部创伤（=0.057）似乎与创伤性凝血病的发生有关。男性比女性更容易发生创伤性凝血病（=0.018）。到达急诊室时，出现心动过速或 SI 及其衍生指标的改变可早期发现创伤性凝血病患者。
